Lio/Levo testing protocol advice

[bluejourney]

On the advice of my (private) endo, I am currently trialling 15 mcg Lio (in 3 doses: 8 am, 1 pm and 6pm) and 75 mcg Levo 11.30 pm, and I need to re-test in a few weeks. I am wondering about the testing protocol, as if I test by 9 am, this dosing regime is the opposite of what’s usually recommended when testing. Previously before testing I’ve left 24 hours gap for Levo and 8 hours for Lio. I’d be grateful if anyone has got any advice on the best testing protocol when in this position.

[Jaydee1507 Administrator]

There are pinned posts about test timings: healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

[DippyDame]

Looking at your earlier posts the addition of T3 makes sense but the way it is being introduced does not!

Success with T3 depends on a dosing protocol that is right for you as an individual

Trying to unpick your dosing and hoping I've understood your journey so far!

You reached 87.5mcg T4, now reduced to 75mcg

Did endo reduce T4 at same time as adding T3?

If so not good practice....easier and clearer to monitor if only one change at a time

15mcg (3×5mcg) T3 to start with, would be far too much for most people.

How are you feeling?

Have you optimised vit D, vit B12, folate and ferritin to support thyroid function?

Having Hashi's are you gluten free?

We need to have "all our ducks in a row"

Starting on a low dose is important eg 5mcg ( which you might split into 2x 2.5mcg as a gentle introduction) for first week if that feels ok then add second 5mcg dose, wait another week and add 3rd dose. Monitor any symptoms/ changes carefully

Note....raised resting heart rate, any hand tremors, anxiety, over heating etc which all suggest over medication.

(Some people even need to start with 2.5mcg....we are all different but medics often forget this!)

The risk of suddenly introducing 15mcg is that the body needs time to adjust to T3, which is a more potent hormone than T4, and may react negatively to it initially.....I usually say it can be like adding high octane racing fuel to an old Mini.....Woosh!!

If that happens the endo might say T3 isn't suiting you and then withdraw your prescription. ( which suits some of them!!)....so best to adopt the low and slow approach and hang on to the T3!!

as if I test by 9 am, this dosing regime is the opposite of what’s usually recommended when testing.

We do recommend testing before 9am to achieve the highest TSH.....

However FT3 followed by FT4 are the most important markers after diagnosis...not TSH.

thyroidpatients.ca/2021/07/...

Testing protocol remains....24hr gap between last T4 dose and test and 12hr gap for T3: no food or drinks except water before test : test at 9am then start hormones again after test

I need high dose T3-only to function so understand how sensitive T3 can be....low and slow is the way to success!

Good luck!

[bluejourney in reply to DippyDame]

Thanks for your reply. Vit B12, Vitamin D, folate, ferritin all ok, and I’ve been gluten and lactose free for many years. The endo did reduce the T4 at the same time as introducing T3, and I didn’t go up to 15 mcg T3 straight away, I’ve been titrating up slowly over months. The trial this time was changing WHEN I take the doses, hence my problem with the dosing protocol.

[DippyDame in reply to bluejourney]

Ah, sorry, I thought you had just start this trial...my mistake!